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PubMedDate not supplied

Planning, implementation, and process monitoring for prehospital 12-lead ECG diagnostic programs.

Prehospital 12-lead electrocardiographic (ECG) diagnostic strategies have been proven feasible and effective, provided they are designed and implemented properly. The authors of this communication have expended considerable time and effort in determining appropriate planning, implementation, and process monitoring necessary for successful implementation of a variety of prehospital diagnostic strategies. Many of these issues may not be obvious to an emergency medical services (EMS) director initiating a 12-lead ECG program. This level of attention to protocol development, education, training, inservice education, coordination of the health-care community, objective program assessment, monitoring and continuous quality improvement can serve as a model for other diagnostic EMS programs that may develop as an expanded role for EMS.

Electrocardiography↗
PubMed2001

Replacing prelinguistic behaviors with functional communication.

This study evaluated the effectiveness of a teacher-implemented intervention package designed to replace prelinguistic behaviors with functional communication. Four young children with autism participated in a multiple-probe design across three communicative functions. Initially, three existing communication functions were selected for each child. Next, the existing prelinguistic behaviors that the children used to achieve these functions were identified. Replacement forms that were considered more recognizable and symbolic were defined to achieve these same functions. After a baseline phase, teachers received inservice training, consultation, and feedback on how to encourage, acknowledge, and respond to the replacement forms. During intervention, the replacement forms increased and prelinguistic behaviors decreased in most cases. The results suggested that the teacher-implemented intervention was effective in replacing prelinguistic behaviors with alternative forms of functional communication.

Autistic Disorder↗
PubMed2003

Effective medical waste management: it can be done.

BACKGROUND: It was noticed that a large volume of medical waste was being generated for incineration at our hospital. The 2 incinerators at our facility were unable to effectively deal with the load of waste and, therefore, were operating for extended periods of time. This caused a significant amount of soot and other emissions to be produced as pollutants into the surrounding environment, which is considered to be a real health hazard. METHODS: A waste-management plan was introduced that included education, mandatory inservice training, auditing of the type and volume of waste generated by each department, and introduction of a written policy on waste management. RESULTS: Within a few months of implementation of the waste-management plan, the amount of medical waste was reduced by more than 58%, from 609 skips/mo (2000 kg/day) in the year 1999, to 256 skips/mo (850 kg/day) in the year 2000; skips are steel containers filled with infectious waste. This reduction was maintained throughout the year 2001 and lead to a 50% reduction in total financial costs (17,936 US dollars) with savings in fuel of 5262 US dollars, labor-cost savings of 8990 US dollars, and maintenance and spare parts savings of 3680 US dollars. CONCLUSIONS: This article discusses problems encountered in waste management in our health care facility, solutions and control measures introduced, and achievements. It also demonstrates that effective waste management can reduce health risk, save money, and protect the environment.

Hospitals↗
PubMedDate not supplied

Coping with AIDS: strategies for patients and staff in drug abuse treatment programs.

HIV infection creates difficulties for patients and staff in drug abuse treatment programs. This article reviews significant problems and coping strategies, drawing on experience in a drug abuse treatment program where a third of the patients are HIV infected. Patient-related problems include denial, anger, depression, and isolation. The coping strategies that patients use can exacerbate their illness. Effective coping strategies may involve the development of mutual-support groups and public education. Staff-related problems include the fear of infection, protecting confidentiality, the need to develop new treatment goals, and recognizing the limitations of drug abuse treatment. To lessen the fears of infection, programs can exercise clear body substance precautions, conduct frequent inservice training, and hold periodic updates for staff. To adequately protect confidentiality, programs can keep up with rapidly changing laws and guidelines. To modify treatment goals, programs can alter admission standards for HIV-infected patients, change treatment methods to minimize the impact of occasional relapses, develop medical referral networks, and give special consideration to counselors who treat HIV-infected patients. To cope with the limitations of drug abuse treatment, programs can support counseling staff in coping with emotionally stressful clinical problems and to avoid burnout.

Acquired Immunodeficiency Syndrome↗
PubMed1985

The impact of the first gay AIDS patient on hospice staff.

AIDS, a recently discovered, contagious, potentially fatal disease has created alarm in some segments of our society. Policy makers in hospices and all facilities that care for dying patients can benefit from the experience of others who have already cared for AIDS patients. This article is a report about the experiences of care givers in hospice settings that have received only a few AIDS patients, all of whom were young, gay males. The psychosocial impact of AIDS patient care on hospice staff is one of the issues that must be addressed if the experience is going to be a positive one for both the hospice and the patient/patient family. Three suggestions are made about hospice procedures that may decrease problems: successful acknowledgement of institutional and personal fear and anxiety; adequate inservice training; development of strong support networks.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Maximizing foodservice in an inpatient hospice setting.

The philosophy of maximizing patient comfort and enhancing quality of life impacts on all aspects of foodservice in an inpatient hospice setting. The foodservice department's focus in the palliative care environment is to meet patients' physical, psychological, and social needs. The menu incorporates variety and comfort foods to meet the special requests of hospice patients. Food production and delivery provides for flexibility in meal preferences and meal serving times. Finally, sanitation standards and inservice training extend beyond the main foodservice operation to include the hospice "family" kitchen to protect the hospice patient from food-borne infections.

Efficiency, Organizational↗
PubMed1979

Continuing education: an attitudinal survey of physical therapists.

A descriptive study of 903 physical therapists located primarily in southeastern United States was undertaken to determine their attitudes toward continuing education and the types of course offerings they desired. A majority of physical therapists kept themselves up-to-date in professional practice, mainly through discussion with colleagues, study groups, and inservice training sessions. The continuing education courses they preferred were comparatively recent topics in physical therapy education--such as musculoskeletal assessment and mobilization--specific neurophysiological approaches to treatment of adults and children, and administration. The study also revealed the preferred schedule, length, type, and cost of continuing education courses, as well as the amount of advance notice preferred and willingness to complete preassigned readings. The main problem that respondents had in participating in continuing education was that courses did not fit into their schedules. A majority of respondents favored mandatory continuing education for relicensure.

Attitude↗
PubMed1998

An ADHD educational intervention for elementary schoolteachers: a pilot study.

We assessed the effect of pediatrician-led inservice training on the knowledge and stress of elementary schoolteachers related to attention-deficit/hyperactivity disorder (ADHD). The subjects were 44 schoolteachers staffing a 750-student school. Preintervention and postintervention questionnaires assessed teachers' training and knowledge concerning ADHD, teacher stress, and teacher-rated student behavior. The intervention was an ADHD curriculum developed by the national organization, Children and Adults with Attention-Deficit Disorder (CHADD). At preintervention, 41% of the teachers thought that ADHD could be caused by poor parenting and 41%, by sugar or food additives; 64% thought that methylphenidate should be used only as a last resort. Postintervention percentages of teachers holding these beliefs were 7%, 5%, and 34%, respectively. Sixty-one percent had no contact with physicians prescribing stimulants. Teacher stress correlated with ADHD behavior in male students and decreased postintervention. Use of the CHADD curriculum and discussion with a pediatrician were associated with improved teacher knowledge and decreased teacher stress related to ADHD.

Adult↗
PubMed1998

Risk of blood contamination of health care workers in spine surgery. A study of 324 cases.

STUDY DESIGN: The relative risk of blood contamination during spine surgery was studied using data collected from 324 procedures. OBJECTIVES: To analyze demographic factors that predict blood-borne pathogens in the population of spine surgery patients, study the rates and patterns of blood contamination in health care workers (i.e., skin-penetrating incidents and nonpenetrating surface skin contamination from patients' blood) and compare those risks with those in other surgical departments, and analyze the effectiveness of barrier systems worn by the surgical team. SUMMARY OF BACKGROUND DATA: The Centers for Disease Control and Prevention has reported 49 health care workers infected by the human immunodeficiency virus through occupational exposure. Several studies have noted the risk of blood contamination in various surgical departments, but the relative risk during spine surgery has not been determined. METHODS: This year-long survey included 9795 cases, or 60,789 health care worker--patient contacts, of which spine disorders comprised 324 cases (2234 health care workers and patients). Data collection forms were designed and inservice training conducted with operating room staffs. Information regarding type of case, staff position (surgeon, assistant, scrub nurse, circulator), protective clothing worn, length of operating room time, blood loss, incidence of blood spills, was recorded, among other data. RESULTS: Prevalence of human immunodeficiency virus in patients in the overall series was 0.19% versus 0.93% in spine patients. The rate of HCW contamination in the overall series was 7.76%, of which 0.92% resulted from skin-penetrating incidents. Contamination in spine surgery occurred in 31.86% of cases, of which 1.23% were the result of skin-penetrating incidents. CONCLUSIONS: Health care workers in spine surgery have a statistically significant overall higher risk of blood contamination than do those in other surgical departments. The increased risk occurred with blood contacting intact skin. There was no higher risk for skin penetrating injury. Analysis of data suggests that health care workers always should wear double gloves, forearm-reinforced gowns, and eye protection.

Blood-Borne Pathogens↗
PubMed1996

Professionals' perceptions of psychotropic medication in residential facilities for individuals with mental retardation.

Professional staff in four state facilities for individuals with mental retardation were surveyed to determine their perceptions, knowledge and opinions regarding the use of psychotropic medication. A large majority of the 377 respondents indicated that the physicians in their facilities were primarily responsible for medication-related decisions. Under ideal conditions, however, all professional staff and parents were seen as having a greater influence in the decision-making process. Aggression, delusions and hallucinations, self-injury, other psychiatric disorders, and anxiety were rated as disorders most likely to result in medication therapy. Behaviour modification was viewed as a suitable alternative to drug treatment for acting out and aggression. The professionals indicated that behavioural observation was the most influential assessment technique in current usage, followed by global impressions and informal diaries. Over 80% of the respondents perceived their preservice and inservice training on issues related to the use of psychotropic medication to treat behaviour problems as inadequate, with 96% of them desiring continuing education. These findings were compared to data from similar studies of populations with other disabilities, and suggestions for modifications in the current decision-making processes related to the use of psychotropic medication in institutionalized individuals with mental retardation are discussed.

Adolescent↗
PubMed1986

Skills development by medical students and the influence of prior experience: a study using evaluation by students and self-assessment.

Research was carried out into the effectiveness of an innovative, problem-based introductory course which was designed to help medical students, within a traditional curriculum, to bridge the gap between theoretical study during the first 4 years and inservice training during the next 2 years. Comparison of exit and entry self-assessment ratings of students showed a marked rise for history-taking and physical examination and a smaller rise for diagnosis and patient management. Cross-study of these self-assessment ratings and the background variable of past medical training showed that prior active experience within the health care system appeared to have a favourable influence on both history-taking and more intellectual skills, notably diagnosis and patient management. History-taking, however, could be taught as effectively during the introductory course. This was not so for the more intellectual skills. The results of this research plead for early active experience within the health care system during the medical curriculum, in order to give the students more insight into the clinical relevance of their theoretical studies. Evaluation by the students of the teaching formats used to reach the learning objectives was favourable, especially of those formats related to concrete practical skills such as live simulated (programmed) patients. It was rather unfavourable to self-study facilities which provide more theoretical knowledge.

Clinical Competence↗
PubMed1993

Development and organizational structure of an acute pain service in a major teaching hospital.

Pain management is an essential part of postoperative care. The present availability of multiple modalities of patient controlled and continuous regional analgesia requires the reorganization of existing hospital structures to be efficacious and safe. This article presents an Acute Pain Service (APS) as a model for a reorganized structure. Although anaesthesia based, this service requires close co-operation of surgeons, nurses and other paramedical personnel to achieve the expected results. Prerequisites of an APS are careful selection of suitable techniques as well as the formulation of protocols and standing orders for the techniques. Inservice training of involved personnel, dedicated single ward trials and introduction of the revised technique for general use are further essential steps in its development. The organizational structures proposed include selection of the appropriate technique for a patient by the theatre anaesthetist, preparation and documentation by the recovery nurse, monitoring and ongoing skilled assessment by the ward nurse and ward rounds, advice and 24 h availability by anaesthetists.

Acute Disease↗
PubMed1993

Nursing home medical directors: ideals and realities.

OBJECTIVE: To evaluate what nursing home medical directors actually do, what they and other nursing home personnel believe would be desirable to do, and what problems and deficiencies are perceived. DESIGN: Mail survey with follow-up telephone interview when necessary. SETTING: Forty-five nursing facilities in upstate New York. PARTICIPANTS: The medical directors, administrators, and directors of nursing of the 45 facilities. MEASUREMENTS: Inventory of what medical directors reported as to their actual activities and time spent, and of what they, the administrators, and the directors of nursing felt should be their responsibilities and activities under ideal circumstances. RESULTS: For part-time medical directors, self-reported time spent on medical directorship activities averaged 12 hours per month; of all directors, 45% spent 8 hours or less per month. Proportion of time spent on various specific activities varied widely. There was general agreement that substantially more time should be spent, in particular, on evaluating and addressing problems of adequacy and quality of care, communicating with attending physicians about problems, and assisting with inservice training programs. CONCLUSIONS: To fill the role adequately, more time should be spent by many part-time medical directors, which will require greater financial commitment by facilities and reimbursement systems. Efforts need to made to better coordinate the expectations of medical directors and facility staff.

California↗
PubMed1996

Effects of an inservice workshop on the health teaching self-efficacy of elementary school teachers.

This study examined the effectiveness of a 30-hour health education inservice training for elementary school teachers. Effectiveness was assessed by measuring pretest to post-test (eight months apart) differences in health teaching self-efficacy, amount of time per week teaching health education, and amount of effort on specific health content areas. Workshop participants scored significantly higher than control teachers on efficacy expectations, outcome expectations, and outcome value subscales. Workshop participants also reported spending significantly more hours per week teaching health education and expending significantly more effort on a variety of specific health content areas than controls.

Adult↗
PubMedDate not supplied

Preferences for an influences on oral health prevention: perceptions of directors of nursing.

Directors of Nursing (DONs) from 196 of 206 Nebraska long-term-care (LTC) facilities were sent a pre-tested questionnaire. The aim was to assess available on-site dental services, existing oral health education and prevention programs as well as future needs/preferences, and the influence of 10 factors in assessing and maintaining residents' oral health. Of the 196 DONs contacted, 126 (64%) participated. Only 36% of DON responders reported having on-site dental services. DONs indicated a preference for nursing staff (NS) oral health inservice training over other educational and/or programmatic proposals. When asked to select the five most influential factors in assessing and maintaining residents' oral health in their respective facilities, DONs selected resident factors (mean, 2.8) more often than NS factors (mean, 2.2). DONs most often identified residents' (R') ability to perform oral hygiene (n = 99), R' cooperation with OH assistance (n = 98), R' interest in their oral health (n = 83), NS interest in R' dental health (n = 70), and NS time constraints (n = 69).

Aged↗
PubMed1975

Organizing a staff development department: the Fort Logan Model.

The staff development department at the Fort Logan Mental Health Center in Denver was created to increase interdisciplinary coordination and participation in student- and continuing-education programs. A great deal of interdisciplinary competition was evident at the beginning. Eventually, continued interaction and expanding needs for members' skills eliminated most competition, and staff were able to learn from one another. Most of the staff now have multiple capabilities and are effective not only in teaching but also in systems intervention. The department's services include a preservice program, which is responsible for student and professional training programs; inservice- and continuing-education programs; and a consultation program.

Colorado↗
PubMed1978

Developing a psychiatric inpatient service in a rural area.

An inpatient psychiatric service was developed in a community hospital in Appalachia by building on the hospital's existing mental health components, a comprehensive alcoholism program and an inservice training program for general-duty nurses. In its first phase, the program offered a consultation service to help physicians deal with emotional problems of medical-surgical patients and a daytime therapy program for selected patients referred by the consultation service. In the second phase, psychiatric patients were admitted directly from the community and placed in wards throughout the hospital. Eventually a separate 23-bed psychiatric unit was opened. Between 1973 and 1976 more than 2200 patients were treated by the therapy service or as psychiatric inpatients. The author discusses problems that occurred during each phase of development, including a continuing shortage of nursing staff.

Hospital Bed Capacity, 300 to 499↗